Collecting Cancer Data: Brain and Central Nervous System January 6, 2011 NAACCR 2010-2011 Webinar Series Agenda Coding Moment Overview Multiple Primary/Histology Rules Collaborative Stage Treatment Fabulous Prizes NAACCR 2010-2011 Webinar Series 1
Coding Moment Coding Moment Multiple Tumor Data Items Multiplicity Counter Date of Multiple Tumors Date of Multiple Tumors Flag Type of Multiple Tumors Reported as One Primary Multiplicity Counter 1. Code number of tumors abstracted as single primary 2. Use any part of medical record to find information on number of tumors; source not limited to path report final diagnosis 3. Do not count metastatic tumors 4. Include foci in multiplicity counter when there are tumors with separate measured single or multiple foci 5. Include measured satellite lesions in the multiplicity counter NAACCR 2010-2011 Webinar Series 2
Multiplicity Counter 6. Use code 01 Single tumor in primary site Single tumor with separate unmeasured tumor foci 7. Use code 02 Tumor is multifocal and there are 2 measured foci Single tumor with multiple foci and 1 is measured Multiplicity Counter 8. Use codes 00-87 and 99 for solid tumors including Ill-defined sites; plasmacytoma, NOS; plasmacytoma, extramedullary; mast cell sarcoma; malignant histiocytosis; Langerhans cell histiocytosis; histiocytic sarcoma; Langerhans cell sarcoma; dendritic cell sarcoma; myeloid sarcoma 9. Use code 88 for Leukemia, lymphoma, immunoproliferative disease & certain hematpoietic neoplasms, unknown primary Multiplicity Counter 10. Use code 99 for Original path report not available & documentation does not specify single or multiple tumors in primary site Tumor is described only as diffuse or disseminated Tumor is described as multifocal or multicentric and number of tumors is unknown Op or path report describes multiple tumors but does not give number Unknown if single or multiple tumors and multiple primary rules instruct to default to single tumor NAACCR 2010-2011 Webinar Series 3
Multiplicity Counter 10. Use code 99 for Number of tumors is not specified for prostate primary including positive biopsy in different lobes of prostate Only information available for inapparent prostate cancer is positive needle biopsy Multiplicity Counter Examples Final diagnosis: Focus of invasive ductal carcinoma, 1.2 cm, and foci of low-grade DCIS in right breast Multiplicity counter = 01 Final diagnosis: Bilateral ovarian papillary serous cystadenocarcinoma, 2 cm tumor in right ovary and 1 cm tumor in left ovary; malignant peritoneal implant. Multiplicity counter = 02 Multiplicity Counter Examples Patient presented with large mediastinal mass. CT showed no intraparenchymal lung tumor. Biopsy of mediastinal mass revealed adenocarcinoma consistent with lung primary. Multiplicity counter = 99 Sextant biopsies of right and left lobes of the prostate: Poorly differentiated adenocarcinoma in both lobes. Multiplicity counter = 99 NAACCR 2010-2011 Webinar Series 4
Date of Multiple Tumors Date of Multiple Tumors Flag Non-date values not valid (codes 00000000, 88888888 and 9999999) in date fields beginning in record layout version 12 Valid dates transmitted in Date of Multiple Tumors data item Date of Multiple Tumors Flag data item replaces non-date information previously transmitted in Date of Multiple Tumors data item Type of Multiple Tumors Reported as One Primary Code 00: Single tumor Code 10: Multiple benign tumors Code 11: Multiple borderline tumors Code 12: Benign and borderline tumors Code 20: Multiple in situ tumors Code 30: In situ and invasive tumors Type of Multiple Tumors Reported as One Primary Code 31: Polyp & adenocarcinoma Code 32: FAP with carcinoma Code 40: Multiple invasive tumors Code 80: Unknown in situ or invasive tumors Code 88: Not applicable for site Code 99: Unknown Includes disseminated or diffuse with no further information NAACCR 2010-2011 Webinar Series 5
Type of Multiple Tumors Reported as One Primary Examples 1/14/11 right lumpectomy; final path diagnosis: Multifocal invasive ductal carcinoma, 1.3 cm and 0.9cm, and lowgrade DCIS Type of Multiple Tumors Reported as One Primary 30 (in situ and invasive) Overview Central Nervous System (CNS) CNS Primaries Estimated new cases and deaths from brain and other nervous system cancers in the United States in 2010: New cases: 22,020 Deaths: 13,140 NAACCR 2010-2011 Webinar Series 6
Case Eligibility for CNS Tumors Include ICD-O-3 malignant (behavior code 2, 3) and ICD- O-3 nonmalignant (behavior code 0, 1) diagnosed on or after 1/1/2004 tumors of the following sites: Meninges (C70._) Brain (C71._) Spinal cord, cranial nerves, and other parts of CNS (C72._) Pituitary gland (C75.1) Craniopharyngeal duct (C75.2) Pineal gland (C75.3) Anatomy Image source: NCI VisualOnline; Artist Alan Hoofring Cerebrum NAACCR 2010-2011 Webinar Series 7
Cerebral Lobes The Ventricular System 23 Cerebellum and Brain Stem Image source: NCI VisualOnline; Artist Alan Hoofring NAACCR 2010-2011 Webinar Series 8
Meninges C70.0 C70.9 Image source: NCI VisualOnline; Artist Alan Hoofring Cerebral Meninges Brain Stem Pons: portion of brain stem superior to medulla oblongata Medulla oblongata: lower potion of brain stem Olive: pair of oval structures in medulla oblongata Pyramid: anterior or ventral portion of medulla oblongata Midbrain: mesencephalon; front of brain stem Cerebral peduncle: ventral portion of midbrain NAACCR 2010-2011 Webinar Series 9
Spinal Cord Begins in the medulla oblongata Cauda equina is the distal end Meninges cover and protect http://kidney.niddk.nih.gov/kudiseases/pubs/u imen/images/nervesignals.gif] 28 Cranial Nerves Brain_human_normal_inferior_view.svg: Patrick J. Lynch, medical illustrator 29 Intracranial Endocrine Glands and Related Structures Image source: NCI VisualOnline; Artist Alan Hoofring NAACCR 2010-2011 Webinar Series 10
Location of Intracranial Tissues Image source: SEER Training Website Location of Intracranial Tissues Supratentorial sites Cerebrum Frontal, temporal, parietal, and occipital lobes Meninges of cerebrum Ventricle, NOS Lateral & 3rd Corpus callosum Tapetum Anterior cranial fossa Middle cranial fossa Suprasellar Infratentorial sites Cerebral subsites Hypothalamus Pallium Thalamus Cerebellum Meninges of cerebellum Brain Stem 4 th ventricle Posterior cranial fossa Sequence Number Records sequence of malignant and nonmalignant neoplasms over patient s lifetime 00-59 and 99 for malignant and in situ behavior 00 = solitary malignant neoplasm 01 = first of multiple malignant neoplasms 60-88 for non-malignant behavior 60 = solitary non-malignant neoplasm 61 = first of multiple non-malignant neoplasms NAACCR 2010-2011 Webinar Series 11
Laterality CNS sites defined as paired for cases diagnosed 1/1/2004 and after Cerebral meninges C70.0 Cerebrum C71.0 Frontal lobe C71.1 Temporal lobe C71.2 Parietal lobe C71.3 Occipital lobe C71.4 Olfactory nerve C72.2 Optic nerve C72.3 Acoustic nerve C72.4 Cranial nerve, NOS C72.5 Assign laterality as 0 for all other CNS sites WHO Grade for Tumors of Brain and Meninges WHO Grade I Slow growing and nonmalignant WHO Grade II Relatively slow growing; sometimes recur as higher grade; nonmalignant or malignant WHO Grade III Malignant by definition; tend to recur as a higher grade WHO Grade IV Rapidly reproducing and most malignant; very aggressive 2007 Multiple Primary and Histology Rules NAACCR 2010-2011 Webinar Series 12
Benign and Borderline CNS Tumors Benign and Borderline/Malignant Benign and borderline intracranial and CNS neoplasms must meet two conditions to be reportable: The histology must be reportable AND The primary site must be reportable Cranial Tumors Report neoplasms described as intradural or intracranial Do not report cranial neoplasms described as extradural NAACCR 2010-2011 Webinar Series 13
Intraspinal Tumors Intraspinal neoplasms arising in the dura of the spine. The spinal dura is loosely attached to the spine which creates a space that is extradural (not in the dura itself) but intraspinal (within the space created by the spinal dura). This intraspinal space contains the spinal nerve roots. Neoplasms arising in the spinal nerve roots and the dura covering the spinal cord nerve roots are reportable (C720). Intraspinal Tumors The spinal nerves extending from the spinal canal are covered with dura. Neoplasms arising from the dura covering the spinal cord roots are meningiomas. The neoplasms arising in the spinal nerve roots are primarily schwannomas and neurofibromas. The peripheral nerves are the portion of nerve extending beyond the spinal dura. Benign /0 or borderline /1 neoplasms of the peripheral nerves are not reportable. Question Is an intradural extramedullary Schwannoma of the spinal canal reportable? NAACCR 2010-2011 Webinar Series 14
Answer Schwannomas are reportable when they are found in cranial nerves or intradural intramedullary (nerves within spinal cord). Extramedullary schwannomas occur in nerves outside the spinal cord and would not be reportable. (I & R Team 48565 10/15/2010 Meningioma Slow growing Develop from the meninges Most are benign (WHO Grade I) Often detected via imaging Treatment is usually surgery Multiple Primary Rules Benign and Borderline Brain Tumors NAACCR 2010-2011 Webinar Series 15
Multiple Tumors Rule M3 An invasive brain tumor (/3) and either a benign brain tumor (/0) or an uncertain/borderline brain tumor (/1) are always multiple primaries. Multiple Tumors Rule M8 Tumors with two or more histologic types on the same branch in Chart 1 are a single primary. Rule M9 Tumors with multiple histologic types on different branches in Chart 1 are multiple primaries. Rule M10 Tumors with two or more histologic types and at least one of the histologies is not listed in Chart 1 are multiple primaries. Chart 1: Benign and Borderline Intracranial and CNS Tumors Chart (abbreviated) Glial Tumor Ependymomas Neuronal and Neuronalglial Neoplasms Subependymoma (9383/1) Myxopapillary Ependymoma (9394/1) Subependymal Giant Cell Astrocytoma(9384/1) Desmoplastic Infantile Astrocytoma (9412/1) NAACCR 2010-2011 Webinar Series 16
Multiple Tumors Rule M11 Tumors with ICD-O-3 histology codes that are different at the first (xxxx), second (xxxx) or third (xxxx) number are multiple primaries. Note: Use this rule when none of the histology codes are listed in Chart 1. Non-Malignant CNS Histology Tumors Histology Rules Single Tumor Rule H2 Code the histology when only one histologic type is identified. Rule H3 When there are multiple histologies and all histologies are in the same branch on Chart 1, code the more specific histology. NAACCR 2010-2011 Webinar Series 17
Chart 1 (abbreviated) Nerve Sheath Tumor Neurofibromas Neurinomatosis Neurothekeoma Neurofibroma (nos) Neurofibromatosis, (nos) Melanotic neurofibroma Neuroma Perineuroma (nos) Pop Quiz A patient with a history of ependymoblastoma (9392/3) diagnosed and treated in 1994 is diagnosed with a meningioma (9530/3). How many primaries does this patient have? How should we sequence this? Pop Quiz A patient presents with a tumor in the left lateral ventricle. Pathology from a stereotactic biopsy showed a tumor with features of subependymoma (9394/1) and choroid plexus papilloma (9390/0). How many primaries? What histology (ies) would you assign? NAACCR 2010-2011 Webinar Series 18
Malignant CNS Tumors Neuroepithelial Malignant Brain and CNS Tumors Chart 1 Pg 72 Chart 2 Non-neuroepithelial Malignant Brain and Central Nervous System Tumors Non- Neuroepithelial Peripheral Nerve Germ Cell Tumors Meningioma, malignant Perineurioma, malignant (9571) Germinoma (9064) NAACCR 2010-2011 Webinar Series 19
Multiple Primary Rules Malignant CNS Tumors Multiple Tumors Rule M6 A glioblastoma or glioblastoma multiforme (9440) following a glial tumor is a single primary (See Chart 1). Glioblastoma: A malignant rapidly growing Astrocytoma of the central nervous system. These neoplasms grow rapidly, invade extensively, and occur most frequently in the cerebrum of adults. Any glial tumor can recur as a glioblastoma or a glioblastoma multiforme NAACCR 2010-2011 Webinar Series 20
Multiple Tumors Rule M7 Tumors with ICD-O-3 histology codes on the same branch in Chart 1 or Chart 2 are a single primary. Rule M8 Tumors with ICD-O-3 histology codes on different branches in Chart 1 or Chart 2 are multiple primaries. Tumor 1: Astrocytoma (NOS) Tumor 2: Anaplastic astrocytoma NAACCR 2010-2011 Webinar Series 21
Tumor 1: Astrocytoma (NOS) Rule M7: One primary Anaplastic astrocytoma Tumor 2: Astroblastoma Tumor 1: Astrocytoma (NOS) Tumor 2: Astroblastoma Rule M8: Two primaries Tumor 1: Astrocytoma (NOS) NAACCR 2010-2011 Webinar Series 22
Histology Rules Malignant CNS Tumors Single Tumor Rule H3 Code 9382/3 (mixed glioma) when at least two of the following cells and/or differentiation are present: Astrocytic Oligodendroglial Ependymal Single Tumor Rule H4 Code the histology when only one histologic type is identified. Rule H5 Code the specific type when the diagnosis includes a nonspecific term and a specific term or type on the same branch in Chart 1 or Chart 2. Rule H6 Code the histology with the numerically higher ICD-O-3 code. NAACCR 2010-2011 Webinar Series 23
Questions? Collaborative Stage Data Collection System CSv02.03 Central Nervous System (CNS) Schemas 71 CNS Schemas Do not use CSv02.03 schemas until your registry software and database have been converted to CSv02.03 NAACCR 2010-2011 Webinar Series 24
CSv02.03 CNS Schemas Schema Name Site Code Brain C70.0, C71.0-C71.9 CNSOther C70.1, C70.9, C72.0-C72.5, C72.8-C72.9 IntracranialGland C75.1, C75.2, C75.3 73 CSv02.03: Brain Brain & Cerebral Meninges Cerebral meninges Cerebrum Frontal lobe Temporal lobe Parietal lobe Occipital lobe Ventricle Cerebellum Brain Stem Overlapping lesion of brain Brain, NOS CS Extension: Brain & Cerebral Meninges Supratentorial sites by ICD-O-3 code C71.0 except hypothalamus, pallium, thalamus C71.1-C71.5 C71.8: Corpus callosum, tapetum C71.9: Anterior cranial fossa, middle cranial fossa, suprasellar NAACCR 2010-2011 Webinar Series 25
CS Extension: Brain & Cerebral Meninges Infratentorial site by ICD-O-3 code C71.0: Hypothalamus, pallium, thalamus C71.6-C71.7 C71.9: Posterior cranial fossa CS Extension: Brain & Cerebral Meninges Benign or borderline brain tumor Code 050 Tumor confined to brain or cerebral meninges Supratentorial tumor Infratentorial tumor Crosses midline Crosses tentorium cerebelli Extends beyond brain or cerebral meninges CS Extension: Brain & Cerebral Meninges 300 100 110 200 120 Image source: Wikipedia NAACCR 2010-2011 Webinar Series 26
CS Extension: Brain & Cerebral Meninges 400 500 510 Image source: Wikipedia CS Extension: Brain & Cerebral Meninges Code 600 Tumor invades: Bone (skull); major blood vessels; meninges; nerves, NOS; spinal cord/canal Code 700 OBSOLETE DATA RETAINED AND REVIEWED V0203 Code 750 Extension to: Nasal cavity; nasopharynx; posterior pharynx; other direct extension outside CNS CSv02.03: CNSOther Other Parts of CNS Spinal meninges Meninges, NOS Spinal cord Cauda equina Olfactory nerve Optic nerve Acoustic nerve Cranial nerve, NOS Overlapping lesion of brain & CNS Nervous system, NOS NAACCR 2010-2011 Webinar Series 27
CS Extension: Other Parts of CNS Code 050 Benign or borderline tumor Code 100 Tumor confined to tissue or site of origin Code 300 Localized, NOS Code 400 Meningeal tumor infiltrates nerve; nerve tumor infiltrates meninges (dura) CS Extension: Other Parts of CNS Code 500 Adjacent connective/soft tissue; adjacent muscle Code 600 Brain for cranial nerve tumors; major blood vessels; sphenoid & frontal sinuses (skull) Code 700 Brain except for cranial nerve tumors; bone other than skull; eye CSv02.03: IntraCranialGland Pituitary gland Craniopharyngeal duct Pineal gland NAACCR 2010-2011 Webinar Series 28
CS Extension: Intracranial Glands Code 000 In situ, intraepithelial, noninvasive Code 050 Benign or borderline tumor Code 100 Invasive tumor confined to gland of origin Code 300 Localized, NOS CS Extension: Intracranial Glands Code 400 Adjacent connective tissue Code 600 Adjacent organs/structures Pituitary gland & craniopharyngeal duct Cavernous sinus; infundibulum; pons; sphenoid body & sinuses Pineal gland Infratentorial and central brain CS Mets at DX: Brain & Cerebral Meninges Code 00 None Code 10 OBSOLETE DATA RETAINED AND REVIEWED V0203 Code 20 Metastasis within CNS and cerebrospinal fluid (CSF) pathways; drop metastasis NAACCR 2010-2011 Webinar Series 29
CS Mets at DX: Brain & Cerebral Meninges Code 30 Metastasis outside the CNS; extra-neural metastasis Code 50 30 + 20 Code 85 OBSOLETE DATA RETAINED AND REVIEWED V0203 Code 99 Unknown CS Mets at DX Other Parts of the Central Nervous System Intracranial Glands Code 00 None Code 10 Distant lymph nodes Code 40 Distant metastasis except distant lymph nodes Code 50 40 + 10 Code 60 Distant metastasis, NOS Code 99 Unknown Other CS Data Items in CSv02.03 Schemas CS Tumor Size/Ext Eval = 9 CS Lymph Nodes = 988 CS Lymph Nodes Eval = 9 Regional Nodes Positive = 99 Regional Nodes Examined = 99 CS Mets Eval = 9 NAACCR 2010-2011 Webinar Series 30
Site-specific Factors in CNS Schemas Site-specific Factor Brain CNSOther IntracranialGland SSF1: WHO Grade X X X SSF2: Ki-67/MIB-1 Labeling Index X X X SSF3: Karnofsky Performance Scale X X SSF4: Methylation of MGMT X X SSF5: Chromosome 1p: LOH X X SSF6: Chromosome 19q: LOH X X SSF7: Surgical Resection X X SSF8: Unifocal vs Multifocal Tumor X X SSF1: World Health Organization (WHO) Grade Classification WHO classification system Combines tumor nomenclature with an associated grading system Do not code WHO grade in the grade data item SSF1: WHO Grade Classification Code Description 010 Grade I 020 Grade II 030 Grade III 040 Grade IV 988 Not applicable 998 No histologic examination of primary site 999 Not documented in medical record; unknown; WHO grade not stated NAACCR 2010-2011 Webinar Series 31
SSF2: Ki-67/MIB-1 Labeling Index (LI) Positive stains for Ki-67 indicate actively growing tumor KI-67 labeling index may be correlated with clinical course of cancer MIB-1 is monoclonal antibody that detects Ki-67 so test may be referred to as Ki-67 or MIB-1 Ki-67/MIB-1 labeling index is expressed as a percentage SSF2: Ki-67/MIB-1 Labeling Index (LI) Code Description 000 0% Labeling index (LI); LI stated as 0%; LI stated as less than 0.5% 001-100 1-100% (Exact LI rounded to nearest percent) 200 LI stated as normal and no percentage provided 300 LI stated as slightly elevated and no percentage provided 400 LI stated as elevated and no percentage provided 888 OBSOLETE DATA CONVERTED V0200 988 Not applicable 997 Test ordered, results not in chart 998 No histologic exam of primary site; test not done 999 Unknown; not documented in patient record SSF3: Functional Neurologic Status Karnofsky Performance Scale (KPS) Code Description 000 KPS 0 010 KPS 10 020 KPS 20 030 KPS 30 040 KPS 40 050 KPS 50 060 KPS 60 070 KPS 70 080 KPS 80 090 KPS 90 100 KPS 100 888 OBSOLETE 988 Not applicable 999 Unknown NAACCR 2010-2011 Webinar Series 32
SSF4: Methylation of O6-Methylguanine- Methyltransferase (MGMT) MGMT is DNA repair enzyme Methylation of MGMT shuts down DNA repair MGMT methylation is a molecular test SSF4: Methylation of O6-Methylguanine- Methyltransferase (MGMT) Code Definition 010 Gene status methylated; hypermethylated; high levels of methylation 020 Gene status unmethylated; low levels of methylation 888 OBSOLETE DATA CONVERTED V0200 988 Not applicable 998 No histologic exam of primary site; test not done 999 Unknown; not documented in patient record SSF5 and SSF6: Loss of Heterozygosity (LOH) Loss of heterozygosity (LOH) Test on tumor tissue to identify loss of genetic material Chromosome 1p: LOH and Chromosome 19q: LOH Tests may be performed at the same time and reported as a single report NAACCR 2010-2011 Webinar Series 33
SSF5: Chromosome 1p: Loss of Heterozygosity (LOH) Code Definition 010 Test positive for LOH 020 Test negative for LOH 888 OBSOLETE DATA CONVERTED V0200 988 Not applicable 997 Test ordered, results not in chart 998 No histologic exam of primary site; test not done 999 Unknown; not documented in patient record SSF6: Chromosome 19q: Loss of Heterozygosity (LOH) Code Definition 010 Test positive for LOH 020 Test negative for LOH 888 OBSOLETE DATA CONVERTED V0200 988 Not applicable 997 Test ordered, results not in chart 998 No histologic exam of primary site; test not done 999 Unknown; not documented in patient record SSF7: Surgical Resection Code Description 000 No surgery of primary site; autopsy only 010 Tumor destruction, NOS No specimen sent to pathology 020 Local excision (biopsy) of tumor, lesion or mass Specimen sent to pathology 021 Subtotal resection of tumor, lesion, or mass of brain (Less than half of lobe involved with tumor) Specimen sent to pathology 022 In brain schema OBSOLETE DATA REVIEWED AND CHANGED V0203 In CNSOther schema Resection of tumor of spinal cord or nerve NAACCR 2010-2011 Webinar Series 34
SSF7: Surgical Resection Code Description 030 Radical, total, gross resection of tumor, lesion or mass in brain (Less than half of lobe involved with tumor) (Not applicable for spinal cord or spinal nerve primary) 040 Partial resection of lobe of brain (Tumor involves more than half of lobe) (Not applicable for spinal cord or spinal nerve primary) 055 Gross total resection of lobe of brain (lobectomy) (Tumor involves more than half of lobe) (Not applicable for spinal cord or spinal nerve primary) 090 Surgery, NOS 988 Not applicable 999 Unknown if surgery performed; death certificate only Not documented in patient record CS SSF8: Unifocal vs Multifocal Tumor Code Definition 001 Unifocal/solitary tumor 002 Multifocal tumor; tumor described as multifocal or multicentric 988 Not applicable 999 Unknown Standard Setters SSF Requirements Commission on Cancer and NCI/SEER Brain & CNSOther: SSF1, SSF4, SSF5, SSF6 IntracranialGland: SSF1 CDC/NPCR Brain, CNSOther, IntracranialGland: SSF1 Canadian Council of Cancer Registries Brain & CNSOther: SSF1 SSF2, SSF5, SSF7, SSF8 if info is available in path report SSF3, SSF6 if info is available in clinical chart IntracranialGland: SSF1 NAACCR 2010-2011 Webinar Series 35
Treatment Surgical Vocabulary Craniectomy Surgery performed on the skull where pieces of bone are removed to gain access to the brain, and the bone pieces are not replaced. Craniotomy Surgery performed on the skull where a portion of bone is removed to gain access to the brain, and the bone is put back in its place Surgical Vocabulary Craniotomies are often named for the bone being removed Some common craniotomies include: Fronto-temporal Parietal Temporal Sub-occipital NAACCR 2010-2011 Webinar Series 36
Surgical Vocabulary Retro-sigmoid craniotomy Through an incision behind the ear, a small craniotomy is placed that allows access to the cerebellum, and areas along the side of the cerebellum and brainstem. Supra-orbital craniotomy Through an incision within the eyebrow, a small craniotomy is placed above the orbit to access tumors under or within the frontal lobes and around the pituitary gland. Surgical Vocabulary Gross Total Resection Complete removal of a tumor as measured by the surgeon's observation (not by a microscope) Surgery Codes NAACCR 2010-2011 Webinar Series 37
Surgery Codes 20 Local excision of tumor, lesion or mass; excisional biopsy Used when the surgeon describes the procedure biopsy, or excisional biopsy, or when there are no details about the procedure Unknown whether total or partial tumor resected 21 Subtotal resection of tumor, lesion or mass in brain Near total, partial, subtotal, debulking, open biopsy (if residual tissue) 22 Resection of tumor of spinal cord nerve Surgery Codes 30 Radical, total, gross resection of tumor, lesion or mass in brain The resection of the brain tissue surrounding the tumor is limited to ensure clean margins. New code can be used with all cases regardless of diagnosis year. Surgery Codes 40 Partial resection of lobe of brain, when the surgery can not be coded as 20-30. Less than lobectomy, but more than it would be necessary to ensure clean margins (when you can not code to 20 or 30) 55 Gross total resection Lobectomy NAACCR 2010-2011 Webinar Series 38
Radiation External beam radiation Codes 20 30: Orthovoltage, cobalt, photons, electrons, or neutrons Code 31: Intensity modulated radiation therapy IMRT Code 32: Conformal radiation 3D conformal radiation Treatment Modality Radiosurgery Code 40: Particle or proton beam Code 41: Stereotactic radiosurgery NOS Code 42: Linac radiosurgery Cyberknife Code 43: Gamma knife Systemic Treatment Be sure to check any drugs that are being given in SEER Rx. http://seer.cancer.gov/tools/seerrx/ NAACCR 2010-2011 Webinar Series 39
Chemotherapy Chemotherapy Carmustine (BCNU) Intravenous Gliadel wafer (Intra-operative) Temozolomide NCCN Guidelines Glioblastoma Multiforme NCCN Guidelines High grade glioma NAACCR 2010-2011 Webinar Series 40
Questions? 121 Thank YOU!!! Next Month s webinar Collecting Cancer Data: Testis 2/3/2011 122 NAACCR 2010-2011 Webinar Series 41
Brain and CNS Terms and Definitions 72 Malignant Meninges, Brain, Spinal Cord, Cranial Nerves, Pituitary gland, Craniopharyngeal duct and Pineal gland Equivalent Terms, Definitions, Charts and Illustrations C700, C701, C709, C710-C719, C720-725, C728, C729, C751-C753 (Excludes lymphoma and leukemia M9590-9989 and Kaposi sarcoma M9140) Chart 1 Neuroepithelial Malignant Brain and Central Nervous System Tumors Note: This chart is based on the WHO Classification of Tumors of the brain and central nervous system. The chart is not a complete listing of histologies that may occur in the brain or central nervous system. Chart Instructions: Use this chart to code histology. The tree is arranged in descending order. Each branch is a histology group, starting at the top with the least specific terms and descending into more specific terms. Neuroepithelial (9503) Embryonal tumors Ependymal tumors Pineal tumors Choroid plexus tumors Neuronal and mixed neuronal-glial tumors Neuroblastic tumors Glial tumors Oligodendroglial tumors Ependymoma, NOS (9391) Anasplastic ependymoma (9392) Papillary ependymoma (9393) Pineoblastoma (9362) Choroid plexus carcinoma (9390) Ganglioglioma, anaplastic (9505 Ganglioglioma, malignant (9505) Olfactory neuroblastoma (9522) Olfactory neurocytoma (9521) Olfactory neuroepithlioma (9523) Oligodendroglioma NOS (9450) Oligodendroglioma anaplastic (9451) Oligodendroblastoma (9460) Atypical tetratoid/rhabdoid tumor (9508) Ependymoblastoma (9392) Medulloepithelioma (9501) Medulloblastoma (9470) Supratentorial primitive neuroectodermal tumor (PNET) (9473) Glioma, NOS (9380) Teratoid medulloepthelioma (9502) Demoplastic (9471) Large cell (9474) Medullomyoblastoma (9472) Neuroblastoma (9500) Ganglioneuroblastoma (9490) Glial tumors of un certain origin Mixed glioma (9382) Astrocytic tumors Astroblastoma (9430) Gliomatosis cerebri (9381) Polar spongioblastoma (9423) Astrocytoma, NOS (9400) Pilocytic astrocytoma (9421) Pleomorphic xanthoastrocytoma (9424) Key:The ovals( )represent group terms. Anaplastic astrocytoma (9401) Fibrillary astrocytoma (9420) Gemistocytic astrocytoma (9411) Protoplasmic astromytoma (9410) Glioblastoma, NOS and Glioblastoma multiforme (9440) Giant cell glioblastoma (9441) Gliosarcoma (9442) Revised November 1, 2007